Provider Demographics
NPI:1255671749
Name:NUTRIENT BALANCE CENTER, LLC
Entity Type:Organization
Organization Name:NUTRIENT BALANCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LN, MS
Authorized Official - Phone:248-291-7722
Mailing Address - Street 1:2585 SUNNYKNOLL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1530
Mailing Address - Country:US
Mailing Address - Phone:248-291-7722
Mailing Address - Fax:248-636-4606
Practice Address - Street 1:2585 SUNNYKNOLL AVE STE 201
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1530
Practice Address - Country:US
Practice Address - Phone:248-291-7722
Practice Address - Fax:248-636-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN201133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty